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Study Detail

El-Kamary, S. S., Higman, S. M., Fuddy, L., McFarlane, E., Sia, C., & Duggan, A. K. (2004). Hawaii’s Healthy Start home visiting program: Determinants and impact of rapid repeat birth. Pediatrics, 114(3), e317–e326.

Program(s) Reviewed: Healthy Families America (HFA)®

Study Screening Details

Screening DecisionScreening Conclusion
Study Passes ScreensEligible for Review

Study Design Details

RatingDesignSampleAttritionBaseline EquivalenceReassignmentConfounding Factors
HighRandomized controlled trialHawaii SampleLowEstablished on race and SES. baseline equivalence on the outcome is not feasible. Partner violence had a statistically significant baseline difference but is included as a control.NoneNone

Study Characteristics

Study Participants Families were recruited to the study between November 1994 and December 1995. Hawaii Healthy Start Program staff screened the medical records of mothers from one of four Oahu communities delivering children at Kapiolani Maternity Hospital for risk factors for child abuse and neglect. Mothers found to be at risk, or those whose records did not contain sufficient information to screen out, were screened further using the Kempe Family Stress Checklist; eligible families were those in which either parent scored 25 or greater (Duggan, 2004a). Of the 897 families who were eligible to participate in the study, 730 (81%) agreed to participate and were randomly assigned to the program group (n = 395), the main comparison group (n = 290), or a testing comparison group (n = 45). 684 families completed a baseline interview (373 families in the program group, 270 families in the main comparison group, and 41 in the testing group comparison). On average, at baseline, mothers were 23.7 years of age (program group) and 23.3 years of age (comparison group). 63% (program group) and 67% (comparison group) of participating families lived below the poverty line. The racial composition of the program group was 34% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 10% Caucasian, and 27% of unknown primary ethnicity. The main comparison group consisted of 33% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 14% Caucasian, and 26% of unknown primary ethnicity. This study reports results from the three follow-ups of the Hawaii Healthy Start randomized controlled trial. In each follow-up year, interviews were completed for 88% of families. 81% of participating families completed all three follow-up interviews.
Setting Six Healthy Start Program sites operated by three community-based organizations in Oahu, Hawaii.
Home Visiting Services Home visiting services were designed to provide three to five years of home visiting, with weekly visits for most or all of the child’s first year of life, and visits of gradually decreasing frequency thereafter depending on family need. Home visitors endeavored to establish trusting relationships with families, help them resolve immediate crises, and help them build on existing strengths to improve their ability to function independently. Visitors helped families develop problem-solving skills, connected them to needed services, and aimed to develop an individual service plan with each family every six months and help the family reach six-month goals. The actual frequency of visits, however, was lower than that specified by the model, with families receiving an average of 13 visits in the child’s first year of life, and 51% of families not actively participating in the program by the time the child was 12 months old. Families still active at the end of year 1 received an average of 22 visits in the first year.
Comparison Condition The main comparison group was tested annually to measure outcomes. A second “testing” comparison group was evaluated only at year 3 to ascertain the effect of repeated testing on observed outcomes (Duggan, McFarlane, Fuddy, Burrell, Higman, Windham, et al., 2004).
Staff Characteristics and Training Trained paraprofessionals were recruited from the community to conduct the home visits (Duggan et al., 1999).
Funding Source Maternal and Child Health Bureau (grant R40 MC 00029, formerly grant MCJ-240637, and grant R40 MC 00123, formerly grant MCJ-240838), the Robert Wood Johnson Foundation (grant 18303), the Annie E. Casey Foundation (grant 94–4041), the David and Lucile Packard Foundation (grants 93–6051, 94–7957, 97–8058, and 98–3448), and the Hawaii State Department of Health (grant 99-29-J).
Author Affiliation None of the study authors are developers of this program model.

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